Question for diabetics

[Cooper]

Over the past couple of years my A1C and Poct Glucose  test results have gone  from borderline to high and back again. My doctor is aggressively treating my diabetes. 

For those of you who are on medication(s) which ones are you on, how long have you been on them, and are they helping? I started out  on Metformin with no results. The doctor then added Glipizide and, most recently, Farxiga. 

I’ve also met with a dietitian and have made some changes in my diet. I’m an   active person and exercise regularly. I’m not overweight and have no family history of diabetes. Yes, I have lost weight on the Metformin. 

I’d appreciate hearing from members who are also diagnosed with diabetes and taking medication. 

 

 

[+ poolboy48220]

I'm on Metformin and Farxiga, for about 4 years now.  I don't pay much attention to my diet - I must be a borderline case because my doctor is happy with my results. 

[+ poolboy48220]

I've switched back & forth between Farxiga & Jardiance, I get the impression they're very similar but I switched because stopped being covered by insurance.  My pharmacist has been excellent about telling me about discount cards available from the pharmaceutical companies.

[pubic_assistance]

1 hour ago, Cooper said:

I’ve also met with a dietitian and have made some changes in my diet.

I'm hypoglycemic, so no medication is available to treat my problem.

In this case the advise of a nutritionist is the only therapy.

Any diabetic could benefit from changing their eating habits. My nutritionist says most Americans have shit eating habits, that lead to diabetes. Changing your habits helps. 

Good luck.

[pubic_assistance]

I consulted a professional nutritionist.

A few major points in fixing the typical American bad eating habits is to switch your schedule around:

Eat your largest meal in the morning, and eat your smallest meal at dinner. Most Americans eat nothing for breakfast and if they do, it's usually just carbs. (cereal, muffins, bagels)  This leads to insulin crashes throughout the day that can cause diabetes and/or hypoglycemia.

Americans eat way too many snacks. Avoid pretzels, chips, crackers and cookies in between meals.

Be sure to eat four meals a day, to help regulate blood sugar.  Including a pre-bedtime meal of yogurt and fruit with granola.

Don't drink fruit juice ( in spite of the false advertising making you think it's healthy ) Eat the whole fruit instead.

 

 

 

 

 

[craigville beach]

2 hours ago, Cooper said:

Over the past couple of years my A1C and Poct Glucose  test results have gone  from borderline to high and back again. My doctor is aggressively treating my diabetes. 

For those of you who are on medication(s) which ones are you on, how long have you been on them, and are they helping? I started out  on Metformin with no results. The doctor then added Glipizide and, most recently, Farxiga. 

I’ve also met with a dietitian and have made some changes in my diet. I’m an   active person and exercise regularly. I’m not overweight and have no family history of diabetes. Yes, I have lost weight on the Metformin. 

I’d appreciate hearing from members who are also diagnosed with diabetes and taking medication. 

 

 

my heart doctor required me to drop Glipizide, he says it is very bad for your heart.   I take Jardiance, and Basaglar with a weekly shot of Trulicity. 

[+ Lucky]

I was recently prescribed Ozempic, but have been waiting ever since as the non-diabetics all want it.

Glipizide has worked wonders with me. I get regular heart checks and have seen no changes since I started it.

[+ purplekow]

Ozempic has been shown to cause weight loss and it is marketed as such under another brand name.  Farxiga and Jardiance have been shown to aid in heart related issues irrespective of whether you have diabetes.  Many of these drugs are not covered by insurance companies are are very expensive.  Glipizide is a very old drug and essentially works by increasing insulin production.  Side effects include hypoglycemia which can be dramatic if you miss meals regularly.  They all assist in the control of diabetes type 2 but the mainstays of treatment is still Metformin and diet and exercise and weight loss if you are overweight.  

[Guest]

On 1/25/2023 at 4:48 AM, Cooper said:

Over the past couple of years my A1C and Poct Glucose  test results have gone  from borderline to high and back again. My doctor is aggressively treating my diabetes. 

For those of you who are on medication(s) which ones are you on, how long have you been on them, and are they helping? I started out  on Metformin with no results. The doctor then added Glipizide and, most recently, Farxiga...

Unclear what you mean by "aggressively," but at some point the harms of aggressive treatment outweigh the benefits, particularly if either SU's, such as glipizide, and/or insulin are used as part of the treatment regimen. In the ACCORD study published in the NEJM some dozen years ago, those treated to Hgb A1c's of 6.4% had worse outcomes, particularly with respect to death, than those treated to Hgb A1c's of 7.5%:

https://www.nejm.org/doi/full/10.1056/nejmoa0802743

"RESULTS

At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257 patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001)."

That being said, if one is only taking medications which can't cause hypoglycemia, the concerns raised by that study probably don't apply. So if your treatment is to be "aggressive," I would recommend medications other than glipizide (or other SU's such as glimepiride, glyburide, etc.) or insulin. Depending on how much Hgb A1c lowering you'll need, either a DPP-4 inhibitor such as sitagliptin (modest drop), or a GLP-1 agonist such as Rybelsus (oral) or Trulicity (weekly injection), which offer a bigger drop in Hgb A1c could replace glipizide. Sitagliptin is incredibly well-tolerated and safe, but one can only expect a drop of 0.8% on the Hgb A1c. GLP-1 agonists definitely have more side-effects, and some manageable safety concerns, but will generally drop Hgb A1c by a good 1.2% or more. 

If cost is an issue, alogliptin is generic now. Sitagliptin was supposed to go generic this month, but Merck sued, and generics don't appear to be available at this time. 

Edited January 26, 2023 by Unicorn

[Danny-Darko]

14 hours ago, Cooper said:

Over the past couple of years my A1C and Poct Glucose  test results have gone  from borderline to high and back again. My doctor is aggressively treating my diabetes. 

For those of you who are on medication(s) which ones are you on, how long have you been on them, and are they helping? I started out  on Metformin with no results. The doctor then added Glipizide and, most recently, Farxiga. 

I’ve also met with a dietitian and have made some changes in my diet. I’m an   active person and exercise regularly. I’m not overweight and have no family history of diabetes. Yes, I have lost weight on the Metformin. 

I’d appreciate hearing from members who are also diagnosed with diabetes and taking medication. 

 

 

I was diagnosed years ago with untreated diabetes. After about 6 years on Metformin, it stopped working for me and my doctors said it was also taxing my kidney functions. I was switched to Jardiance daily dose AND Ozempic once weekly shot. My A1C and blood sugar levels have become what my doctors claim as "acceptable" and are very pleased with my progress, weight loss and my kidney functions have improved. If you have any addtional questions Cooper you may contact me in private chat.  

[handiacefailure]

Long time type 1 here so have to use insulin.    My mom is a t2 and her endo put her on an insulin shot a day in addition to her oral meds and that really helped.   

I use a pump and a dexcom.    If you aren't on a CGM I would really recommend it.    It's helped my control a lot and my endo and GP both prefer time in range over a1c.   

Something that really helps with stubborn highs for me is Afrezza.   They have a program where you can get it free.   Brings my sugars down in about a half hour and is out of my system in 90 minutes so I don't deal with insulin stacking.   My mom used it before she caught covid for high carb meals but she had a bad case of covid that caused lung issues and there is some breath test you have to do every year and she can't pass it now.

[BeamerBikes]

Just a general Kudos for everyone chiming in here.  My parents didn't take care of themselves - lied to themselves when doctors wanted to get more aggressive.  As a result, I lost one parent when I was 17 suddenly. and did long term caregiving for the other from 28 - 40yo.  Unmanaged diabetes lead to a major life altering stroke and eventually being bed bound.  

Diabetes is no joke.  Keep at it.  Applaud everyone for taking their health serious,  chiming in with advice and med experience.  

[Guest]

3 hours ago, Danny-Darko said:

...After about 6 years on Metformin, it stopped working for me and my doctors said it was also taxing my kidney functions...

I believe you misunderstood your doctor(s). (Hopefully, otherwise your doctors were either misinformed or intentionally deceiving you). Metformin doesn't injure or harm one's kidneys. In fact, metformin use protects the kidneys. That being said, metformin does get cleared/excreted by the kidneys, so if your kidney function is especially bad, metformin's not the best choice, especially at higher doses, because a buildup of metformin can lead to a rare dangerous situation called lactic acidosis. However, even the risk of lactic acidosis is greatly overblown (though most physicians won't prescribe it if you have stage IV kidney disease, and Stage IV kidney disease is an official contraindication per the FDA). 

This was a study looking at over 10,000 diabetic patients:

https://diabetesjournals.org/care/article/43/5/948/35706/The-Long-term-Effects-of-Metformin-on-Patients

"...All-cause mortality and incident ESRD [end-stage kidney disease] were lower in the metformin group according to the multivariate Cox analysis. Because the two groups had significantly different baseline characteristics, PSM was performed. After matching, metformin usage was still associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.65; 95% CI 0.57–0.73; P < 0.001) and ESRD progression (aHR 0.67; 95% CI 0.58–0.77; P < 0.001). Only one event of metformin-associated lactic acidosis was recorded. In both the original and PSM groups, metformin usage did not increase the risk of lactic acidosis events from all causes (aHR 0.92; 95% CI 0.668–1.276; P = 0.629)."

https://www.mdpi.com/1422-0067/20/1/42

AKI = Acute Kidney injury

CKD = Chronic Kidney Disease

T2DM = Type 2 Diabetes Mellitus 

"...In several clinical studies, metformin has been shown to improve survival of AKI and CKD patients. In a large cohort of over 25,000 patients with T2DM, Bell et al. [64] provided a reassuring message of the safety of metformin in patients with or without CKD, as mortality was not adversely affected by metformin use. Metformin did not increase the incidence of AKI, and survival rates were higher in patients with AKI previously treated with metformin [64]. In a retrospective cohort study, Stephen et al. [65] linked Scientific Registry of Transplant Recipients data for all incident kidney transplants from 2001 until 2012, and national pharmacy claims. They found that survival was superior for all outcomes for recipients who filled metformin claims compared with those who filled non-metformin agent claims [65]. In an open cohort study of 469,688 T2DM patients, the relationship between a range of complications and antidiabetic therapy was analyzed. Severe kidney failure, including dialysis treatment, kidney transplant, and CKD stage 5, were among the five pre-specified key outcomes. Compared with non-use, metformin was associated with a significantly decreased risk of severe kidney failure, whereas sulfonylureas and insulin increased this risk [66]. In a recent systematic review involving 17 observational studies, metformin use appeared to be associated with reduced all-cause mortality in patients with CKD, congestive heart failure, and chronic liver disease ..."

 

[hassanizhar]

It is important to work closely with your healthcare provider to manage your diabetes, as treatment plans can vary depending on individual factors such as the type and severity of diabetes, as well as other health conditions and medications. Making lifestyle changes, such as diet and exercise, in addition to taking medication can also help improve blood sugar control. It is important to regularly monitor your blood sugar levels and report any concerns or changes in symptoms to your healthcare provider.

[Danny-Darko]

9 hours ago, Unicorn said:

I believe you misunderstood your doctor(s). (Hopefully, otherwise your doctors were either misinformed or intentionally deceiving you). Metformin doesn't injure or harm one's kidneys. In fact, metformin use protects the kidneys. That being said, metformin does get cleared/excreted by the kidneys, so if your kidney function is especially bad, metformin's not the best choice, especially at higher doses, because a buildup of metformin can lead to a rare dangerous situation called lactic acidosis. However, even the risk of lactic acidosis is greatly overblown (though most physicians won't prescribe it if you have stage IV kidney disease, and Stage IV kidney disease is an official contraindication per the FDA). 

This was a study looking at over 10,000 diabetic patients:

https://diabetesjournals.org/care/article/43/5/948/35706/The-Long-term-Effects-of-Metformin-on-Patients

"...All-cause mortality and incident ESRD [end-stage kidney disease] were lower in the metformin group according to the multivariate Cox analysis. Because the two groups had significantly different baseline characteristics, PSM was performed. After matching, metformin usage was still associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.65; 95% CI 0.57–0.73; P < 0.001) and ESRD progression (aHR 0.67; 95% CI 0.58–0.77; P < 0.001). Only one event of metformin-associated lactic acidosis was recorded. In both the original and PSM groups, metformin usage did not increase the risk of lactic acidosis events from all causes (aHR 0.92; 95% CI 0.668–1.276; P = 0.629)."

https://www.mdpi.com/1422-0067/20/1/42

AKI = Acute Kidney injury

CKD = Chronic Kidney Disease

T2DM = Type 2 Diabetes Mellitus 

"...In several clinical studies, metformin has been shown to improve survival of AKI and CKD patients. In a large cohort of over 25,000 patients with T2DM, Bell et al. [64] provided a reassuring message of the safety of metformin in patients with or without CKD, as mortality was not adversely affected by metformin use. Metformin did not increase the incidence of AKI, and survival rates were higher in patients with AKI previously treated with metformin [64]. In a retrospective cohort study, Stephen et al. [65] linked Scientific Registry of Transplant Recipients data for all incident kidney transplants from 2001 until 2012, and national pharmacy claims. They found that survival was superior for all outcomes for recipients who filled metformin claims compared with those who filled non-metformin agent claims [65]. In an open cohort study of 469,688 T2DM patients, the relationship between a range of complications and antidiabetic therapy was analyzed. Severe kidney failure, including dialysis treatment, kidney transplant, and CKD stage 5, were among the five pre-specified key outcomes. Compared with non-use, metformin was associated with a significantly decreased risk of severe kidney failure, whereas sulfonylureas and insulin increased this risk [66]. In a recent systematic review involving 17 observational studies, metformin use appeared to be associated with reduced all-cause mortality in patients with CKD, congestive heart failure, and chronic liver disease ..."

 

Thanks for the clarification but yes, Metformin was no longer the best choice for me, and it was determined Jardiance was because of my kidney disease. Together with Ozempic both have helped me immensely. 

[+ DERRIK]

I started insulin a year ago

moved to Fl.   new doctor preached "wheat belly diet".   each no grains/sugar.  grains = carb = carb become sugar

Wheat belly diet similar to Adkins - Kito

been doing it 7 months

no insulin - jardiance.   metformin 

[+ Lucky]

I finally received my Ozempic today. All of the nondiabetics getting it screwed up the supply.

[handiacefailure]

6 hours ago, DERRIK said:

I started insulin a year ago

moved to Fl.   new doctor preached "wheat belly diet".   each no grains/sugar.  grains = carb = carb become sugar

Wheat belly diet similar to Adkins - Kito

been doing it 7 months

no insulin - jardiance.   metformin 

I love carbs too much to do Keto or anything like it.

I went to a session at a diabetes seminar on the Keto diet and Type 1 diabetes and the speaker was saying some diabetics that are struggling financially will do keto not to lose weight but so they have lower insulin doses and can make their insulin last longer

[dbar123]

I got diagnosed with Type 2 about 13 years ago when I turned 55 (blood sugar at 160). At my doctors advice I first started off with aggressive weight loss which brought my blood sugar to about 120. In time it started creeping up slowly so he put me on Metformin. I’ve been on it for over 10 years (500mg twice daily ) and my A1C is about 5.9. Ive not really had any issues with it but I’ve had to supplement it with aggressive exercise (weightlifting and biking) as well as a 2000 calorie diet. The diet part really sucks.

[Guest]

On 1/26/2023 at 6:51 PM, dbar123 said:

I got diagnosed with Type 2 about 13 years ago when I turned 55 (blood sugar at 160). At my doctors advice I first started off with aggressive weight loss which brought my blood sugar to about 120. In time it started creeping up slowly so he put me on Metformin. I’ve been on it for over 10 years (500mg twice daily ) and my A1C is about 5.9. Ive not really had any issues with it but I’ve had to supplement it with aggressive exercise (weightlifting and biking) as well as a 2000 calorie diet. The diet part really sucks.

You're a good example of how crucial diet and exercise are in the treatment of DM2. In fact, you and your physician should give serious consideration to stopping the metformin. No professional guidelines suggest any Hgb A1c goal of less than 6.5%, and there is nothing to suggest better outcomes for those keeping it under 6%. At the very least, you might as well switch to once-a-day metformin ER (extended release), which is now generic and very inexpensive. But I would suggest stopping it all together, and see where your Hgb A1c lands. If it goes above 6.5%, you could start it again. 

metformin ER (Glucophage XR) 500mg
90 tablets at CVS Pharmacy
Logo of CVS Pharmacy
$21.21
 

When I was in practice, I was able to take a significant number of patients who followed diet and exercise off of meds completely. On the other hand, there were those who wouldn't adjust their diets or activity patterns, and every year or two, it'd be one more medication (including insulin). 

https://diabetesjournals.org/care/article/45/Supplement_1/S83/138927/6-Glycemic-Targets-Standards-of-Medical-Care-in

"Recommendations
6.5a An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate. A

6.5b If using ambulatory glucose profile/glucose management indicator to assess glycemia, a parallel goal for many nonpregnant adults is time in range of >70% with time below range <4% and time <54 mg/dL <1% (Fig. 6.1 and Table 6.2). B

6.6 On the basis of provider judgment and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. B

6.7 Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. B"

(A recommendations have the best evidence)

[dbar123]

22 hours ago, Unicorn said:

You're a good example of how crucial diet and exercise are in the treatment of DM2. In fact, you and your physician should give serious consideration to stopping the metformin. No professional guidelines suggest any Hgb A1c goal of less than 6.5%, and there is nothing to suggest better outcomes for those keeping it under 6%. At the very least, you might as well switch to once-a-day metformin ER (extended release), which is now generic and very inexpensive. But I would suggest stopping it all together, and see where your Hgb A1c lands. If it goes above 6.5%, you could start it again. 

metformin ER (Glucophage XR) 500mg
90 tablets at CVS Pharmacy
Logo of CVS Pharmacy
$21.21
 

When I was in practice, I was able to take a significant number of patients who followed diet and exercise off of meds completely. On the other hand, there were those who wouldn't adjust their diets or activity patterns, and every year or two, it'd be one more medication (including insulin). 

https://diabetesjournals.org/care/article/45/Supplement_1/S83/138927/6-Glycemic-Targets-Standards-of-Medical-Care-in

"Recommendations
6.5a An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate. A

6.5b If using ambulatory glucose profile/glucose management indicator to assess glycemia, a parallel goal for many nonpregnant adults is time in range of >70% with time below range <4% and time <54 mg/dL <1% (Fig. 6.1 and Table 6.2). B

6.6 On the basis of provider judgment and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. B

6.7 Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. B"

(A recommendations have the best evidence)

Thanks for the advice. I will broach this when I have my next physical and bloodwork in a few months.

I've not been averse to taking Metformin since it acts as an mTOR inhibitor which presumably interferes with protein synthesis, and most likely tumor development as well. As my dad died of pancreatic cancer I am more than happy to take something that might help forestall tumor growth.

I actually used to take the extended release metformin but my insurance carrier (Tufts and Caremark) switched me to save a buck. I have a new prescription vendor (OptumRX) and I am curious to see what they will send.

[+ augustus]

On 1/25/2023 at 7:48 AM, Cooper said:

Over the past couple of years my A1C and Poct Glucose  test results have gone  from borderline to high and back again. My doctor is aggressively treating my diabetes. 

I don't have diabetes yet but I was pre-diabetec.  The doctor told me to eat beans and it definitely helped me.  I buy kidney beans and wash off the sauce (especially if it's Goya).  Then I mashed them into a spread and add a little olive oil to give it some moisture, then refrigerate.  Then I spread it on whole wheat toast and a little mayo and it actually makes a pretty good sandwich.  You can add lettuce and tomatoes too.  It lowered my level to near normal.

[Guest]

Beans are very healthful foods, but they make some people blow a lot of hot air out their derrieres.... 😉

[Lookin]

On 2/23/2023 at 10:25 AM, Unicorn said:

Beans are very healthful foods, but they make some people blow a lot of hot air out their derrieres.... 😉

. . . which, left untreated, can lead to more serious consequences such as closure of the Politics Forum.  

As for diabetes, I've been in the pre-diabetic category since I first started tracking the numbers fifteen years ago.  My glucose numbers rose very slowly for the first ten years but never quite reached the level for full-blown diabetes.  I didn't want to take any pills but my GP had learned that Metformin might help with another condition I had, so I started taking 500mg once a day.  My numbers leveled off at that point, just under the level for diabetes.

About three years ago, I started paying more attention to my diet.  I wasn't overweight, but decided it was time for a healthier diet so I started eating more fruits and veggies, whole grains and, yes, even more beans.  And I've noticed that my glucose and A1C numbers have been trending down - not to normal levels, but no longer approaching the level for a diagnosis of diabetes.  I still enjoy my chips, cookies and ice cream, but try not to overdo.

One other factor I've heard may affect diabetes is stress.  I quit my last high-stress job twenty years ago and I don't have any test results from those days.  I wouldn't be surprised if my numbers were worse then.  And, just to be on the safe side, I've done my best to keep aggravation at bay.  

[+ sniper]

If I'm taking metformin for PRE-diabetes and my A1c is holding at 5.4, how long before I talk about going off it? I never got over 5.9 in the first place...